Evaluation of a Nurse Initiated Standardized Protocol for Management of Acute Hypertensive Crisis in Pregnancy

Document Type


Publication Date

Winter 11-19-2020


Hypertensive disorders in pregnancy account for a significant proportion of maternal morbidity and mortality. Doctors Hospital at Renaissance implemented a hypertensive emergency and eclampsia protocol as well as preeclampsia medication toolkits and a Maternal Early Warning System to enable nurses to rapidly identify and treat pregnant women with severe hypertension based on the ACOG recommendations. The purpose of this study is to determine whether a nurse initiated hypertensive emergency and eclampsia protocol has improved the treatment of severe hypertension in pregnant and postpartum patients and overall maternal health outcomes. This study will be a retrospective cohort study from 2012 to 2020 to assess the effectiveness of a Hypertensive Emergency Protocol at Doctors Hospital at Renaissance in responding to and treating Maternal Hypertension. Based on ACOG recommendations, pregnant or post-partum patients meet hypertensive emergency criteria if they have a systolic blood pressure >160 and/or diastolic blood pressure >110. The primary outcomes are time to severe range blood pressure confirmation and time to treatment, with the goal being confirmation within 15 minutes and treatments within 30-60 minutes. Secondary outcomes include severe maternal morbidity and mortality rate and type of antihypertensive used. Based on the current literature, it is expected that initiation of a standardized protocol will decrease time to treatment and reduce severe maternal morbidity and mortality. Similarly, time to treatment and severe maternal morbidity and mortality are expected to decrease even further after initiation of a Maternal Early Warning System and medication toolkits. With severe maternal morbidity and mortality on the rise in the United States, the results of this study are expected to confirm that standardized protocols for hypertensive emergencies can assist in reversing this trend. Furthermore, in a largely homogenous population with higher rates of chronic diseases that increase risk for pregnancy-related complications, this study is essential in providing evidence that the nurse initiated standardized protocol is effective in reducing such complications.

Academic Level

medical student

Mentor/PI Department

Obstetrics and Gynecology

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